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Perspectives on Pass-Through Rebate Models

Posted by Peter Johnson on Mar 4, 2021

With the Trump administration's rebate rule delayed and possibly slated for repeal by Democrats in Congress, major changes in how the PBM industry distributes rebate revenue will have to come from the private sector, AIS Health reported.

The Biden administration will suspend implementation until 2023 of the so-called "rebate rule," a Trump administration regulation that would have revamped the Medicare prescription drug rebate system, and DC insiders expect the regulation will be repealed by Congress before then. Meanwhile, a growing number of PBMs that deal in the commercial market have pitched plan sponsors on a 100% pass-through rebate structure, in which the PBM collects its compensation through a fee or surcharges rather than diverting a share of rebate revenue.
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: 2020 Was 'Breakout Year' for Digital Engagement in Health Care

Posted by Jane Anderson on Mar 4, 2021

Health care organizations, eager for innovative ways to engage members in the midst of the pandemic, ramped up their use of email and texts in 2020 and found they were highly effective at prompting consumer action, a recent survey on health care consumer engagement found.

The survey, conducted annually for the past five years by consulting and research firm Engagys, found when it polled around 100 health care entities in November that 2020 had been a "breakout year" for use of more efficient digital channels and personalized messages, Kathleen Ellmore, the firm's co-founder and managing director, tells AIS Health.

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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: New Heart Failure Drugs Offer More Therapy Options

Posted by Jane Anderson on Mar 2, 2021

Treatment for heart failure still relies significantly on tried-and-true generic drugs, but new brand-name entrants — including Novartis' Entresto (sacubitril/valsartan) and Amgen's Corlanor (ivabradine) — are important additions to prescribers' clinical arsenals against the high-mortality condition, industry insiders tell AIS Health.

"Generic heart failure drugs, including beta blockers, ACE inhibitors, and ARBs [angiotension receptor blockers] have historically been used and continue to be the backbone of therapy," says April Kunze, Pharm.D., senior director of clinical program development for Prime Therapeutics. "However, in the past few years, additional treatment options have become available. Entresto is now recommended as a first-line treatment option in patients with an ejection fraction <= 40%."

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Topics: Industry Trends, Market Access, Product Release

Trends That Matter for Rx Benefits in Medicaid

Posted by Leslie Small on Feb 25, 2021

Beginning in April, California and New York will join a growing list of states that have opted to carve out prescription drug benefits from their Medicaid contracts with insurers, wagering that the state can do a better job at negotiating drug prices with manufacturers than managed care organizations and their contracted PBMs, AIS Health reported.

"I think the pharmacy benefit overall will be something that states are looking at in order to find savings in some way — whether through carveouts or through another policy — just because there are limited levers that the state is going to be able to pull to save money," says Rachel Dolan, a senior policy analyst with the Kaiser Family Foundation’s Program on Medicaid and the Uninsured.
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Topics: Industry Trends, Market Access, Data & Analytics, Payer

Radar On Market Access: Analysts Downplay Stock Selloff Following CVS 4Q Earnings Report

Posted by Leslie Small on Feb 25, 2021

Although CVS Health Corp.'s stock price dropped about 5% after the company reported its fourth-quarter and full-year 2020 financial results on Feb. 16, equities analysts seemed to be unshaken in their view that the firm — which owns health insurer Aetna — has strong fundamentals, AIS Health reported.

For the fourth quarter of 2020, CVS's net income of $975 million was down 44% compared with the prior-year period, a result the company partially attributed to lower operating income driven by the impact of the COVID-19 pandemic on its Health Care Benefits and Retail/Long-Term Care segments. For the full year 2020, CVS's operating income and net income increased relative to 2019.

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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Aetna Plans to Return to ACA Exchanges

Posted by Leslie Small on Feb 23, 2021

Executives at CVS Health Corp. revealed on Feb. 16 that its Aetna insurance division plans to return to the Affordable Care Act exchanges starting in 2022, a move that health care policy experts say underscores the increasing attractiveness of the individual insurance market for carriers. They also indicate that the trend is expected to continue, AIS Health reported.

"After careful consideration, we have decided to reenter the individual public exchange market as of January 1, 2022," newly minted CEO Karen Lynch said during CVS's fourth-quarter earnings call. "As the ACA has evolved, there is evidence of market stabilization and remedies to earlier issues," Lynch added.

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Topics: Industry Trends, Data & Analytics, Payer

Perspectives on Developments to Watch in Pharma

Posted by Leslie Small on Feb 18, 2021

In 2021, the three main "developments to watch" in the branded pharmaceuticals sector will include COVID-19 vaccine scale-up and distribution, continued legislative and regulatory pushback against high drug prices, and robust levels of merger and acquisition activity, according to a new report from Moody's Investors Service.

Regarding vaccines, Moody's noted that Moderna Inc. as well as Pfizer Inc. and its partner BioNTech will continue to ramp up production of their COVID-19 vaccines and distribute them widely throughout 2021.
 
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Topics: Industry Trends, Product Release, Data & Analytics, Payer

Radar On Market Access: Pass-Through Rebate Models Need to Demonstrate Value

Posted by Peter Johnson on Feb 18, 2021

With the Trump administration's rebate rule delayed and possibly slated for repeal by Democrats in Congress, major changes in how the PBM industry distributes rebate revenue will have to come from the private sector, AIS Health reported.

The Biden administration will suspend implementation until 2023 of the so-called "rebate rule," a Trump administration regulation that would have revamped the Medicare prescription drug rebate system, and DC insiders expect the regulation will be repealed by Congress before then. Meanwhile, a growing number of PBMs that deal in the commercial market have pitched plan sponsors on a 100% pass-through rebate structure, in which the PBM collects its compensation through a fee or surcharges rather than diverting a share of rebate revenue.

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Topics: Industry Trends, Market Access, Payer

Radar On Market Access: Publicly Traded Insurers Continue to Tout Pharmacy Divisions

Posted by Leslie Small on Feb 16, 2021

Although the fourth quarter of 2020 brought financial challenges for some health insurers due to surging coronavirus infections, the pharmacy-focused divisions of those publicly traded firms seemed to provide a universal bright spot, AIS Health reported.

Cigna Corp. saw its stock prices slide after its fourth-quarter earnings came in below Wall Street's expectations, but for its health services segment Evernorth — which houses its PBM — full-year 2020 adjusted revenues increased 20% compared with 2019, reaching $30.5 billion. Those results were driven by "ongoing strong retention, the completion of insourcing Cigna volumes and organic growth, including our partnership with Prime Therapeutics," Cigna CEO David Cordani said during the company's earnings conference call.

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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: New Prostate Cancer Treatment Orgovyx Offers Oral Option

Posted by Angela Maas on Feb 11, 2021

People being treated for advanced prostate cancer now have a new oral option. On Dec. 18, the FDA approved Myovant Sciences GmbH’s Orgovyx (relugolix), a gonadotropin-releasing hormone (GnRH) receptor antagonist, to treat adults with advanced prostate cancer, AIS Health reported. Dosing for the drug is a loading dose of 360 mg on the first day of treatment and then 120 mg of the tablet once daily.

Treatment of advanced prostate cancer usually involves androgen deprivation therapy (ADT), and the current standard of care is luteinizing hormone-releasing hormone (LHRH) receptor agonists, such as leuprolide acetate, which is administered by a health care provider as an injection or implant. It is available as AbbVie Inc.’s Lupron Depot and Eligard from Tolmar Pharmaceuticals, Inc. to treat prostate cancer.

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Topics: Industry Trends, Market Access, Product Release